Ghana has been concerned about regional development disparities since the 1970s. To address this concern, several development plans with explicit spatial policies and strategies were crafted for implementation but none of them was successful. During the 1980s and 1990s, economic downturn shifted the focus from spatial restructuring policies to economic restructuring policies. The impact of these policies coupled with the demand for good governance and democratic principles led to the passing of several local government acts that were supposed to strengthen regional development through decentralised decision-making institutions. However, to date, these have not been effective. In 2015, a new national spatial development framework was adopted to guide the country’s regional development effort through to 2035. This chapter examines why regional development policies and practices have been ineffective in Ghana. It argues that the tendency for adopting policies without paying much attention theoretical frameworks that inform the policies is fundamental to why Ghana’s regional development policy and practice has been ineffective. This has led to a gap between the paperwork and what actually occurs on the ground. To avert this, more attention needs to be paid to the structures and mechanisms that are needed to make policies work before adopting the policies.